EstriumEstrium™

Nutritional Support for Symptoms Related to Hormone Cycles

Medical Food

Tropical MangoBasic Recipe

2 scoops Estrium (using the scoop* provided)

8 ounces of liquid (favorite unsweetended fruitor vegetable juice; soy, almond,rice, oat, or organic cow's milk; water)

Shake or blend the productuntil mixed.**

* 1 scoop is approximately 1 level tablespoon

** Important: Do not premix Estriumand save it for later consumption.Estrium should be consumed within30 minutes of mixing. Discard anyunused portion.

Carb & Calorie Conscious“Basic Recipe” MixingVariations

2 scoops Estrium

4 oz. water

4 oz. soy, almond,rice, oat, or organic cow's milk

or

2 scoops Estrium

4 oz. water

4 oz. unsweetened fruit juice

Smoothies For smoothies, substitute 1-3 icecubes and/or fresh fruit for partof the liquid, and blend in ablender until smooth. Frozenfruit may be used instead of icecubes, but you may need to adda little extra liquid. Adjust theamount of liquid to suit yourpersonal taste.

Tropical Breeze2 scoops Estrium

3 oz. water or pineapple-orange juice

3 oz. soy, almond, rice, oat,or organic cow's milk

1 slice pineapple

2-3 ice cubes

Estrium Recipes & Mixing Instructions

Visit www.metagenics.com/estriumfor meal planning suggestions

and exciting food recipes

Tropical Nut2 scoops Estrium

8 oz. almond or soy milk

1 Tbsp. almond butter

Mango-Berry2 scoops Estrium

1/2 cup fresh or frozen blueberries

6-8 oz. almond, soy,or rice milk

2 ice cubes, optional

Mango-Banana2 scoops Estrium

1/2 banana

6-8 oz. almond,soy, or rice milk

2 ice cubes, optional

Creamy Fruit2 scoops Estrium

3 Tbsp. vanilla yogurt

6-8 oz. almond,soy, or rice milk

1 tsp. peach or apricot“all fruit” jam

Other Options To increase your intake of essential omega-3 fatty acids,you may add flaxseed oil orground flaxseed before blending. If you add flaxseed,you will need to add more liquidbefore blending.

Flax ‘n Estrium2 scoops Estrium Mango

8-10 oz. liquid

1-3 tsp. ground flaxseed

Include an additional 2-3 oz.liquid for each teaspoon ofground flaxseed added.

Important note: If you choose to grind your own flaxseed into flax meal(we recommend using a coffee grinder),it should be used immediately or storedin the freezer due to its fragile oils.Defatted flax meal (found in health food stores) contains importantphytonutrients and is more stable,but should also be stored in thefreezer after opening.

Estrium Recipes & Mixing Instructions

Personal Program Notes

Product Amount Frequency Duration

Patient name __________________________________ Date __________________________________

Healthcare practitioner __________________________ Phone ______________________

INSTRUCTIONS (To be completed by your healthcare practitioner)

Mixing Instructionso Mix with water only o Mix with vegetable juiceo Mix with rice or nut milk o Mix with fruit juiceo Mix with soy milk o Mix with other

Estrium Recommendation

Additional dietary recommendations ______________________________________________________

______________________________________________________________________________________

Additional lifestyle recommendations ____________________________________________________

______________________________________________________________________________________

Exercise recommendations ______________________________________________________________

______________________________________________________________________________________

Rest/relaxation recommendations ________________________________________________________

______________________________________________________________________________________

Disclaimer: Metagenics, Inc. makes no representations or warranties, expressed or implied, regarding the use of theEstrium Program, other than those specifically set forth in the printed Patient Guide received with the purchase of theproduct from a licensed healthcare practitioner. Close supervision by a licensed healthcare practitioner is recommendedbefore starting and during the use of this or any other nutritional intervention or dietary/medical food product. Consultyour healthcare practitioner immediately if you feel any discomfort or suffer any adverse health effects during the timeyou are involved in this program.

IMPORTANT WARNING: This product has been formulated to support female patients who have been medically deter-mined to have symptoms related to their hormone cycles. It has not been tested for interactions with oral contraceptivemedications, and the effectiveness of oral contraceptives for birth control cannot be ensured during use of Estrium. Pleasediscuss this important concern with your healthcare practitioner. For further detail, please refer to the Questions & Answerssection in this Patient Guide.

Allergy Statement: This product is produced in a facility that produces other products containing soy, fish, tree nuts, dairy,and crustacean shellfish.

Contents of Guide

Pages

What is the Estrium Program? ..................................................................................1

Why is the Estrium Program Recommended for You? ....................................1

How to Use Estrium ......................................................................................................1

The Estrium Program at a Glance ........................................................................2-5

Estrium Recipes & Mixing Instructions ................................................................6

Helpful Hints ....................................................................................................................7

Suggested Serving Sizes and Food Lists ............................................................7-12

Questions & Answers................................................................................................13-16

What is the Estrium Program?The Estrium Program consists of Estrium medical food and a specially designed dietaryplan. Estrium is a powdered medical food thatcontains a combination of selected nutrientsand phytonutrients that nutritionally supportimportant metabolic (biochemical) functions in your body. The specific nutrients and foodcomponents in Estrium nutritionally supportthe recommended dietary changes and giveyour body additional help in achieving bal-anced hormonal cycles. You can use Estriumwith the dietary plan described in this guide or with an alternative dietary plan individuallytailored by your healthcare practitioner. Insome cases, he or she may recommend additional nutritional support to meet yourindividual needs.

Why is the Estrium Program Recommended for You? Your healthcare practitioner has determinedthat some of your health concerns are associat-ed with your hormone cycles, and has recom-mended that you use Estrium medical foodwith the dietary plan outlined in this PatientGuide. This comprehensive approach isdesigned to provide nutritional support foryour body’s production, use, and excretion ofvarious hormones—but particularly estrogen.For more information on the importance of balanced estrogen metabolism, see Questions& Answers on pages 13-16.

How to Use EstriumEstrium should be used within a special dietaryplan recommended by your healthcare practi-tioner. Estrium may be used as a meal replace-ment, snack, or meal supplement.

Mixing Estrium is as simple as combining 2level scoops of powder with 8 ounces of liquidin a blender or shaker. Great-tasting beveragerecipes and mixing instructions are providedon page 6. Based on the dietary plan you andyour healthcare practitioner select, Estriummay be mixed with a variety of other liquids,fruits, or vegetables.

Everyone is different. Occasionally, some indi-viduals experience gas, bloating, or loose stools,which typically disappear as your body adjusts.If you experience such symptoms, reduce yourserving size to one scoop and build up slowly to the recommended two scoops.

Notice: This product is to be used under the direct supervi-sion of a physician or other licensed healthcare practitioner.Do not engage in any diet supplying less than 800 caloriesper day without medical supervision.

Important note: Your healthcare practitioner may suggest alternative dietary modifications or further nutritional supplementation. He or she will make these decisions based upon your health and your response to the program.

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Consume 1 serving of Estrium for breakfast or as a mid-morning snack and anoth-er as a mid-afternoon snack daily. Choose recipes listed in the Estrium Recipes &Mixing Instructions on page 6. For your convenience, a tear-out list of Estriumrecipes is also included in the front cover of this guide.

Follow the Estrium Dietary Guidelines on page 3 as closely as possible. The tablebelow focuses on foods containing nutrients that may affect hormone activity byinfluencing detoxification and/or excretion of various hormones. For best resultson your Estrium Program, avoid the foods listed in the “Foods to Exclude” column.These may interfere with hormone detoxification or worsen hormonal symptoms.

Legumes All legumes and legume products, especially soy products None

Vegetables All, especially cruciferous1 and sea vegetables None(various seaweeds)

Fruits All whole and dried fruits, especially citrus None

Grains All whole grains and whole-grain products, Non-whole grains, refined flours especially rye and refined flour products

Nuts/Seeds All nuts and seeds and their butters, especially flaxseed, Nonewalnuts, and pumpkin seeds

Fish All, especially cold-water fish: salmon, sardines, tuna, and Salted or cured fishhalibut are an excellent source of omega-3 fatty acids2

Eggs From organically raised hens Non-organic eggs3

Poultry/Meat Organic meats and poultry Non-organic meats and poultry,salted and cured meats3

Dairy Organic dairy products, and soy, nut, and Non-organic dairy products3

grain dairy substitutes

Oils Cold-pressed unrefined seed and nut oils, Refined vegetable oils, butter,especially flaxseed, walnut, sesame, canola, lard, margarine, shortening, and olive, and soy oils4 saturated or hydrogenated fats

Beverages Mineral or filtered water, herbal tea and decaffeinated Alcohol (beer, wine, spirits),herbal tea, fruit juice, and coffee substitutes, especially coffeemint teas and decaffeinated coffee, black tea, cocoa, andbeverages with lemon or lime juice soft drinks

Sweeteners Brown rice syrup, fruit sweetener, molasses, stevia Refined or artificial sweeteners

Spices and herbs Especially nutmeg, anise, thyme, sage, fennel, caraway, Chocolate, high sodium and turmeric; and lemon and lime juice foods, salt

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The Estrium Program at a Glance

1 Cruciferous vegetables include: broccoli, cauliflower, all cabbages, Brussels Sprouts, kale, bok choy, arugula, mustard greens, andwatercress.

2 Omega-3 and some omega-6 fatty acids help to counteract symptoms associated with hormone imbalance and should be consumed daily.

3 Non-organically raised livestock are often given hormones to improve their growth; unfortunately, these hormones can be passedon to the consumer and negatively influence hormone balance.

4 Important: Do not cook with oils that are not specified for cooking or baking, such as flaxseed or walnut oils. Olive, canola, soy, andsesame oils are good choices for cooking or baking. Use flaxseed, olive, sesame, or walnut oils for homemade salad dressings. Theseprovide valuable omega-3 and omega-6 fatty acids. Refrigerate all oils and dressings.

Food Group Foods to Include Foods to Exclude

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Estrium Dietary Guidelines Build your daily menu around the following Daily Recommended Servings list.(Refer to Food Lists and Suggested Serving Sizes on pages 7-12 for approxi-mate serving sizes and helpful hints.)

Category Daily Servings Recommended

Estrium 2 servings

Legumes 1-2 servings, with 1 from soy

Vegetables 3-4 servings, with at least 2 from cruciferous or sea vegetables

Fruits 2-3 servings, with at least 1 from citrus fruits

Whole Grains 2-3 servings, with 1 from flaxseed or rye

Nuts/Seeds 1-2 servings

Fish 0-1 serving, from cold-water fish

Eggs (organic) 0-1 serving, strictly avoid if not organic

Poultry/Meat 0-1 serving, strictly avoid if not organic

Dairy (organic) 0-1 serving, strictly avoid if not organic

Oils 4-6 servings, with at least 1 from flaxseed oil

Beverages 6-8 glasses or more sugar-free, herb teas or water

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*Basic Salad Dressing (about 3 servings)

1⁄4 cup flaxseed oil (or 2 Tbsp. each flaxseed and olive oils)

1-2 Tbsp. vinegar (apple cider, tarragon, rice, red wine, bal-samic, ume plum)

1 tsp. Dijon mustard (optional, but delicious)

Whole or minced garlic, oregano, basil, or other herbs of choice

Mix well and keep in a shaker jar.(store in refrigerator)

Sample Menu when eating in or dining out:

BreakfastOatmeal or cream of rye cereal with soy, nut, grain, or organic cow's milk,sweetened with mashed bananas or applesauce, sprinkled with cinnamonand ground flaxseeds (add stevia if needed)

Grapefruit and orange wedges

Decaffeinated herbal tea or grain beverage

Snack Estrium, 2 scoops, mixed as desired

Lunch Any bean soup (e.g., lentil, black bean) with rye crackers

Tossed salad with chicken or tofu chunks, topped with Basic Salad Dressing*

Mixed berries

Snack Estrium, 2 scoops, mixed as desired

Dinner Broiled salmon or cod

Baked acorn squash or sweet potato and steamed broccoli and cauliflower,tossed with olive or flaxseed oil and herbs of your choice

Tossed green salad with sliced cucumber, radish, and red onion, topped withBasic Salad Dressing*

Snack Hummus with raw vegetables (broccoli, cauliflower, cucumber, carrot)

For more dietary plan details, refer to the Food Lists on pages 11-12. Recipes and additional menu planning ideas are available at www.metagenics.com/estrium

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Tips for Travel and Dining OutIf you travel or take Estrium to work, you can purchase a portable battery-operat-ed mixer (found in many kitchen appliance stores) to use when a blender isn'tavailable. An 8-12 ounce shaker cup with a secure lid is also convenient for mixingthe product.

Important note: Do not premix Estrium and save it for later consumption. Estriumshould be consumed within 30 minutes of mixing. Discard any unused portion.

If you are traveling within the country, you can pack pre-measured servings (2scoops each) of Estrium into plastic sandwich bags. You can also pack or purchasebottled water to mix with the product. (Bottled or filtered water is preferable totap water.) When traveling, Estrium makes an excellent breakfast beverage, a sim-ple between-meal snack, or a bedtime snack. Just remember to consume 2 serv-ings of Estrium daily.

When you know you will be eating meals away from home, it may be impracticalto consume Estrium as part of the meal. It may be best to have the beveragebefore you go out, as you may not be hungry enough to consume Estrium on yourreturn. You can consume Estrium earlier in the day if you anticipate eating outthat day. Plan ahead.

Beyond this ProgramWhen you complete the initial phase of the Estrium Program (generally 8 weeks),you and your healthcare practitioner should discuss your response. Your health-care practitioner may suggest that you continue on the program, continueEstrium or the diet alone, or use some other combination of diet and nutritionalsupplementation. Depending on your response, he or she may suggest takingEstrium only in the second half of your menstrual cycle.

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Tropical Mango Basic Recipe 2 scoops Estrium (using the scoop* provided)

8 oz. of liquid (water; soy, almond, rice,oat, or organic cow's milk)

Shake or blend the product until mixed.Drink within 1/2 hour.

*1 scoop is approximately 1 level tablespoon

Important note: Based on the dietary plan you and yourpractitioner select, Estrium may be mixed with a variety ofother liquids, fruits, or vegetables. If you are restricting calo-ries, you may want to consider diluting your choice of liquid50/50 with water.

Carb & Calorie Conscious“Basic Recipe” Mixing Variations

2 scoops Estrium

4 oz. water

4 oz. soy, almond, rice, oat,or organic cow's milk

or

2 scoops Estrium

4 oz. water

4 oz. unsweetened fruit juice

Estrium Recipes & Mixing Instructions

Tropical Breeze2 scoops Estrium

3 oz. water or pineapple-orange juice

3 oz. soy, almond, rice, oat,or organic cow's milk

1 slice pineapple

2-3 ice cubes

Tropical Nut2 scoops Estrium

8 oz. almond or soy milk

1 Tbsp. almond butter

Mango-Berry2 scoops Estrium 1/2 cup fresh or frozen blueberries

6-8 oz. almond, soy,or rice milk

2 ice cubes, optional

Mango-Banana2 scoops Estrium 1/2 banana

6-8 oz. almond,soy, or rice milk

2 ice cubes, optional

Creamy Fruit2 scoops Estrium

3 Tbsp. vanilla yogurt

6-8 oz. almond,soy, or rice milk

1 tsp. peach or apricot“all fruit” jam

Flax ‘n Estrium2 scoops Estrium

8-10 oz. liquid

1-3 tsp. ground flaxseed

Include an additional 2-3 oz.liquid for each teaspoon ofground flaxseed added.

Other Options To increase your intake of essential omega-3 fattyacids, you may add flaxseedoil or ground flaxseedbefore blending. If you addflaxseed, you will need toadd more liquid beforeblending.

Important note:If you choose to grind your ownflaxseed into flax meal (we recom-mend using a coffee grinder), itshould be used immediately orstored in the freezer due to its fragile oils. Defatted flax meal (found in health food stores) contains important phytonutrientsand is more stable, but should also be stored in the freezer afteropening.

Smoothies For smoothies, substitute 1-3 ice cubes and/or fresh fruit for part of the liquid, and blendin a blender until smooth. Frozen fruit may be used instead of ice cubes, but you mayneed to add a little extra liquid. Adjust the amount of liquid to suit your personal taste.

Food Servings/Day

Legumes 1-2

*Root vegetablesRaw carrotsSweet potatoes

3-4

FruitAppleOrangeGrapes

2-3

Whole GrainsCooked grains/rice

2-3

Nuts/SeedsRaw nutsNut butters

1-2

Fish 0-1 (2-3 per week)

Eggs o-1

Poultry/Meat 0-1

DairyCheeseCottage cheese

0-1

OilsCanola oil Salad dressing

4-6

Beverages 6-8

What does an approximate serving look like?

Here are a few guidelines:

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Helpful Hints

1 Eat foods from the suggested listthat you like.

2 Experiment. Challenge your palate.Try one new food weekly.

3 Increase your intake of vegetables andlegumes (soy, beans, lentils) by eatinghomemade or low-sodium soups anddrinking fresh-pressed vegetable juices.

4 Try ethnic cuisine when dining out.Many Middle Eastern foods (like hum-mus) are tasty, low in fat and calories,and hormone-friendly—in addition tobeing widely available.

5 Learn to visualize serving sizes so that nomatter where you go, you will alwaysknow how to eat healthy portions of theright foods (see pages 9-10).

6 Talk to your healthcare practitioner ifthe amount of food you eat is an issue.Your healthcare practitioner can workwith you to determine how many serv-ings make up a portion size for yourindividual health needs.

Suggested Serving Sizes

*Green leafy vegetables and vegetables that grow above the ground are unlimited.

Servings/Day Serving Size Equivalent Size

1-2 1/2 cup Tennis ball

3-41/2 cup1/2 cup

7-8 baby carrots or carrot sticksBaseball

2-3mediumlarge15

Tennis ballBaseball

2-31/2 cup Full muffin wrapper

1-21o-121 Tbsp. Half a thumb

0-1 (2-3 per week) 3-4 oz. Checkbook

o-1 2 whole

0-1 4 oz. Deck of cards

0-11 oz.3/4 cup

Pair of diceFull 8 oz. disposable coffee cup

4-61 tsp.2 Tbsp.

Thumb tipPing pong ball

6-8 8 oz. Full 8 oz. disposable coffee cup

approximate serving look like?

ere are a few guidelines:

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ving Sizes

Turn the page for

more help

es and vegetables that grow above the ground are unlimited.

What does an approximate serving size look like?

Cheese(1 oz.)

Beverages(8 oz. liquid)

CottageCheese

( 8 oz. cup)

SaladDressing

(2 Tbsp.)

LargeFruit

(e.g., orange)

Vegetables(e.g., salad)

What does an approximate serving size look like?

These pictures will help you estimate recommended serving sizes for a healthy, lifelong diet.

Fish(3-4 oz.)

Legumes(e.g., lentils)

MediumFruit

(e.g., apple)

Poultry/Meat(4 oz.)

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LEGUMES1-2 servings per day Average serving size = 1/2 cup or as indicated

o Split peas, sweet greenpeas, snow peas, sugarsnap peas, lentils

o Beans—garbanzo, pinto,kidney, black, lima,cannellini, navy, mung,green soy

o Fat-free refried beans o Tofu or tempeh, 3/4 cup o Miso, 1 Tbsp.o Hummus, 1/4 cup o Soy milk, 1 cup o Texturized vegetable

protein, 1/3 cup o Soy burger, 4 oz.

VEGETABLES 3-4 servings per dayAverage serving size = 1/2 cupor as indicated

o Asparaguso Artichokes o Bamboo shoots o Beets o Bell or other pepperso Broccoli o Brussels sproutso Burdock rooto Cabbage (all types,

including bok choy)

o Carrotso Cauliflowero Celery and celery rooto Corn o Cucumber o Eggplanto Fennelo Garlic and shallots o Green and yellow beans o Greens—kale, collard,

mustard, beet, watercress,dandelion, chicory, turnip,romaine, red and greenleaf, endive, arugula, radic-chio, escarole, Swiss chard,spinach

o Jalapeño peppers o Jicama o Juice—carrot, tomato, or

vegetable blend o Kohlrabio Mushrooms o Okra o Onion, leeks, chives o Parsnips o Plantainso Potatoes o Radishes (also daikon) o Rutabagaso Salsa (sugar-free) o Sea vegetables—nori,

dulse, hijiki, kelp, kombu,wakame

o Sprouts—alfalfa, bean,broccoli, clover, radish

o Shallotso Sweet potatoes or yams o Tomatoes o Turnips o Water chestnuts, 5 mediumo Winter squash—acorn,

butternut, delicata o Zucchini, yellow or green

summer squash, spaghettisquash

FRUITS 2-3 servings per day Average serving size as indicated

o Apple, 1 medium o Applesauce, 1/2 cup o Apricots, 3 medium o Banana, 1 medium o Berries—blackberries,

blueberries, raspberries,strawberries; 1 cup

o Cantaloupe, 1/4o Cherries, 15 o Currants, 2 tsp.o Dates, 3 o Fresh or dried figs, 2 o Grapes, 15 o Grapefruit, 1 whole o Honeydew melon, 1/4o Juice, unsweetened

(diluted), 1/2 cup o Kiwis, 2 o Lemonso Limeso Mangoes, 1/2o Nectarines, 2 small o Orange, 1 large o Papaya, 1/2o Peaches, 2 small o Pear, 1 medium o Pineapple, 2-3 slices o Plums, 3 small o Prunes, 3 o Raisins, 2 tsp.o Tangerines, 2 small o Watermelon, 1 slice

Foods that are particularly recom-mended are indicated in bold print.Use the Shopping Healthy tear-outlist from the back cover when grocery shopping.

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WHOLE GRAINS 2-3 servings per day Average serving size = 1/2 cupor as indicated (measure aftercooking)

o Whole grains—rye, wheat,amaranth, teff, quinoa,barley, buckwheat, millet,triticale, spelt, kamut

o Basmati or other brownrice, wild rice

o Bulgur (cracked wheat),whole wheat berries

o Oat bran, corn bran,wheat bran, rice bran

o Cereals—low sugar,healthy brown rice, oat orwheat cereals

o Whole oats, raw, 1/3 cup;cooked oatmeal, 3/4 cup

o Cream of rye, rice,or barley cereal

o 100% whole-wheat, spelt,kamut, or rice pasta, 1/2 cup

o Whole-grain rye crackers, 2 o Bread/rolls—mixed

wholegrain, sproutedgrain, 100% whole-rye,1 slice

o Whole-wheat, spelt,or corn tortillas, 1

o Whole-wheat pita, 1 o Brown rice cakes, 2

NUTS/SEEDS 1-2 servings per day Average serving size as indicated

o Almonds, cashews,hazelnuts, walnut orpecan halves, 8-10

o Flaxseed, sunflower,pumpkin, sesame seeds,2 Tbsp.

o Nut butters, 1 Tbsp.

FISH 2-3 servings per week Average serving size = 3-4 oz. or asindicated (measure after cooking)

Grilled, baked, roasted,or poached

o Fish (especially cold-water) cod, flounder, hal-ibut, herring, mackerel,pollock, salmon (fresh orsmoked), sardines, smelt,snapper, tuna, trout,shellfish

EGGS 0-1 serving per day (organic) Average serving size = 2

o Organic eggs, 2 whole o Organic egg whites, 3,

PLUS 1 whole egg

POULTRY/MEAT 0-1 serving per day (organic)Average serving size = 3-4 oz. or asindicated (measure after cooking)

Grilled, baked, or roasted

o Poultry—organic chicken,Cornish hen, turkey

o Organic lamb, beef, pork o Wild game—venison, elk,

buffalo, pheasant, quail

DAIRY 0-1 serving per day (organic) Average serving size as indicated

o Organic yogurt, plain, 8 oz.o Organic milk, 8 oz.o Hard cheese, 1 oz.o Cottage cheese, 3/4 cup o Ricotta, 1/2 cup o Parmesan cheese, 2 Tbsp.

grated o Tofu cream cheese, 2 Tbsp.o Soy, almond, rice cheese, 1 oz.o Soy, grain, nut milks, 8 oz.

OILS 4-6 servings per dayAverage serving size = 1 tsp.or as indicated

Oils should be cold-pressed

o Flaxseed oil o Other oils—extra virgin

olive oil, canola, soy,almond, sunflower,sesame, safflower, walnut,pumpkin

o Mayonnaise (canola oil-based)

o Ripe or green olives, 8-10medium

o Avocado, 1/8

BEVERAGES 6-8 glasses or more per day Average serving size = 8 oz.

o Decaffeinated green orherbal tea

o Grain beverages o Mineral, filtered water o Seltzer, plain or flavored o Diluted fruit juices (1/2

juice, 1/2 water) o Nut milkso Rice, oat, or other grain

milks

CONDIMENTS/SPICES Unlimited servings

Anise, bay leaf, caraway, car-damom, carob, celery seed,coriander, fennel seed, mint,dry and prepared mustard,horseradish, kudzu, rose-mary, sage, thyme, turmeric,vinegar, saffron, tarragon,parsley, oregano, marjoram,garlic, ginger, cumin, dill,chives, cinnamon, chili pow-der, bonito flakes, basil

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1 Why is it important to supportmy body's ability to excrete orremove estrogen?

The ebb and flow of a woman’s sex hormoneshave a natural rhythm, and a woman mayexperience as many as 500 menstrual cyclesfrom puberty to menopause. A woman’s men-strual rhythm may be influenced by factorsthat include her lifestyle, genetics, chemicalexposures, current and past health, history ofpregnancy and childbirth, and even her moth-er’s health in pregnancy. The phases of awoman’s menstrual cycle depend on certainhormones (such as estrogen and progesterone)triggering one another as their levels naturallyrise and fall in a carefully orchestrated fashion.

However, in modern times of high stress, pollu-tion, and unbalanced diets, many women’smenstrual cycles lose their delicate hormonalbalance.

Does estrogen balance effecthow I feel?

For premenopausal women (generally underthe age of 45), problems with estrogen balancemay manifest as premenstrual syndrome, irreg-ular menstrual cycles, fibrocystic breast disease,endometriosis, dysmenorrhea (menstrualcramping), and/or menorrhagia (heavy men-strual bleeding). During perimenopause (gener-ally between the ages of 45 and 55) women can

also experience problems with estrogen bal-ance, but at this time it may manifest as hotflashes, night sweats, anxiety attacks, and/orheart palpitations.

How important is my dietand regular exercise?

Estrogen balance is crucial in the cycle. Lifestyleand other previously mentioned factors caninfluence estrogens in various ways. Estrogensnormally circulate through the body and influ-ence various activities at a cellular level. After atime, they are broken down (detoxified) andexcreted. The body can detoxify estrogens invarious ways, which may increase or decreasetheir hormonal strength. A woman’s diet, physi-cal activity, stress level, and chemical exposuresinfluence the way her body detoxifies estro-gens. Therefore, our lifestyle choices can influ-ence our hormone cycles!

A key example of a lifestyle choice is the con-sumption of foods or beverages that contain saturated fats, alcohol, pesticide residues, or hormones. These can overload our organsresponsible for detoxification and excretion orincrease our exposure to “foreign” sources ofestrogen. However, we can eat in a way thathelps us detoxify and excrete estrogens safely.For some women, supporting natural hormonebalance through diet, nutrition, and lifestylemodification may provide many health benefits.That is what the Estrium Program is all about.

Questions & Answers

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4 What are the best choiceswhen eating out?

Eating out can be a challenge. Try to stick toorganic dairy and meat because of the poten-tial hormone residues. It can be difficult,although not always impossible, to find organicbeef, poultry, eggs, and dairy products. Lamb,even when not organic, might be a safer optionas it is often grass fed. Vegetarian meals areanother healthy option. Ethnic Indian restau-rants have many lamb choices and deliciousvegetarian meals, as do many Asian restau-rants. Seafood restaurants are easy to find andoffer cold-water fish, such as salmon, as ahealthy alternative. Fast food restaurantsshould be a last choice; salad bars would be asafer bet here.

Can men follow this program? This program has been designed especially forwomen, but men may also benefit from follow-ing the Estrium dietary plan and/or consumingEstrium. Estrium and the dietary guidelineswere studied in relation to women’s healthconcerns, but some research suggests that theymight also provide nutritional support formen’s health. A man’s healthcare practitionershould determine if he could benefitfrom the product or dietary plan.

Is this program safe for children and adolescents?

The nutritional content of Estrium is based onadult Recommended Daily Allowances, and ithas not been tested with children or adoles-cents. However, under the supervision of ahealthcare provider, Estrium may be appropri-ate as a supplement for adolescents. Your clini-cian must help you decide if and how the prod-uct may be used by adolescents.

I am allergic to soy. Can I still follow this program?

Yes. Estrium is a rice-based medical food and is free of soy protein. The Estrium dietary plancan be adjusted to be soy-free as well. Estriumis manufactured without soy, wheat, gluten,dairy, egg, corn protein, artificial colors, andartificial flavors. This makes it useful for indi-viduals with food allergies or intolerances.

I am allergic to rice. Can I still follow this program?

Possibly. The rice protein in this product ismade through a patented process that appearsto decrease the allergic potential of rice pro-tein. Consult with your healthcare practitioner.

Does this program work if I am inmenopause?

This program offers nutritional support for pre-and perimenopausal (before menopause)women when there are wide fluctuations inestrogen levels. Women in menopause havespecialized nutritional needs that may not befully satisfied by the Estrium Program. Yourhealthcare practitioner can determine if youcould benefit from all or part of the program.

Can I use Estrium or this dietaryplan as a preventive measure formaintaining hormonal balance?

Estrium and the Estrium Program have notbeen tested in this way. However, long-termuse of either the product or the dietary planmay benefit women with these tendencies.Your healthcare practitioner should decidewhether or not this is a good option for you.

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Should I take supplements duringthe Estrium Program?

Because this product contains therapeutic lev-els of carefully selected nutrients that providestrategic nutritional support, and becausesome supplements contain substances thatcould interfere with hormone detoxification,we suggest that you follow the recommenda-tions of your healthcare practitioner.

For how long will I need to follow this program?

Clinical experience suggests that patients usu-ally show benefits within four to eight weeks(or one to two menstrual cycles) on the pro-gram. Your healthcare practitioner may, afterfurther assessment, suggest that you continuethe program to obtain or sustain these benefits.

Can I follow this program if I amdiabetic or hypoglycemic?

Probably, but Estrium has not been testedunder these conditions. You should make thisdecision only with the guidance of your health-care practitioner, discussing integration of thisprogram into your prescribed diet.

Can I follow this program if I ampregnant or nursing?

No. Estrium has not been tested under theseconditions and it is not recommended for useat these times.

I seem to experience increasedgas or bloating while takingEstrium. Why is this?

Some patients experience minor symptoms ofgas or bloating, which may be due to the fiberor mineral content of Estrium. Generally yourbody will adjust to this dietary change withinone to two weeks. If you experience symptomsas you increase your serving size, you canreturn to your previous comfortable servingsize for a few days before increasing it again. Besure to drink additional water to help with theincreased level of fiber in your diet, and bringany unusual symptom to the attention of yourhealthcare practitioner.

Do I need to follow this dietaryplan or can I just use Estriumalone?

Estrium can be used without the accompany-ing dietary plan. However, for best results, theyhave been designed to be used together.

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11Questions & Answers

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Why does this dietary plan specifyorganic meat and dairy productsfor those who choose to consumeanimal products?

Livestock that are not raised organically areoften administered hormones to increase theirweight more rapidly. Unfortunately, smallamounts of these hormones may be passed onto those who consume these non-organic ani-mal products. In women with symptoms relatedto hormone cycles, exposure to "foreign" (notnaturally produced by the body) hormones maybe undesirable. By consuming organic animalproducts, you may reduce your exposure to "for-eign" hormones found in today's food supply.

What are the brown flecks left inthe bottom of the glass after Iconsume Estrium?

This is ground defatted flaxseed, an importantingredient in Estrium. Be sure to drink all of theproduct.

My digestive system doesn'thandle legumes very well.What can I do?

Legumes are high in protein and fiber and low infat. To increase your tolerance for legumes,increase your intake slowly over the course oftwo to three weeks. You can try cooking thebeans with one or two pieces of kombu sea-weed, or try soaking the beans in water and dis-carding the water before cooking. You may alsofind that certain legumes work better for youthan others. Experiment. Lentils and soybeansare generally easy to tolerate. Over-the-counterenzymatic aids can also be used.

I've heard that soy raisesestrogen levels. Why is soyin this dietary plan?

Soybeans and soy products are often referred toas "phytoestrogens," though they do not raiseestrogen levels. In the body, phytoestrogens("phyto-" means plant) act as weak estrogensthat, under some circumstances, compete withor complement the body's stronger estrogens inperforming estrogen-related functions.Phytoestrogens can behave like the body's estro-gens in some ways, but with a fraction of theirstrength. Therefore, phytoestrogens may actuallydecrease the "estrogen message" that the bodyreceives. This may be beneficial for women withsymptoms related to hormone cycles.Phytoestrogens found in flax, rye, kudzu, and inother legumes have similar properties. Thesefoods nutritionally support hormone detoxifica-tion and excretion as well.

I take oral contraceptives (birthcontrol pills). Can I use Estrium?

This product has been formulated to supportfemale patients who have been medically deter-mined to have symptoms related to their hor-mone cycles. Our clinical experience suggeststhat women who use oral contraceptives andhave hormone cycle-related symptoms may ben-efit from using Estrium. However, in a clinicalstudy we performed, some women using oralcontraceptives while using Estrium experiencedmenstrual bleeding at times other than theirusual menstrual period. This product has notbeen tested for interactions with oral contracep-tive medications, and the effectiveness of oralcontraceptives for birth control cannot beensured during use of Estrium. If you are usingoral contraceptives as a means of birth control,you may want to consider using an additionalmethod of birth control while you are using thisproduct and for one month after discontinuinguse of this product. Please discuss this impor-tant concern with your healthcare practitioner.

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Shopping Healthy

Whole Grains o Whole ryeo Whole wheato Barley o Oatso Whole corn o Brown rice—

all varietieso Amaranth o Milleto Teff o Quinoa o Buckwheato Triticaleo Spelto Kamuto Bulgur (cracked

wheat) o Brans—corn, oat,

wheat, and rice o Brown rice cakes o Brown rice pasta o Whole-grain pasta o Cream of rice o Cream of rye o Cream of barley o Puffed rice o Whole-grain rye or

wheat crackers o Breads:

o Sprouted grain o 100% rye o 7-grain o Whole-wheat,

spelt, or corn tortilla

o Whole-wheat pitao Whole-wheat,

rye, or spelt rolls

Nuts/Seeds o Almonds o Cashews o Flaxseed or flax meal o Hazelnuts o Pecans o Pine nuts o Pumpkin seeds o Sesame seedso Sunflower seeds o Walnutso Nut butters

Fish, Eggs, Poultry/Meat, Dairy o Organic eggs

Organic dairy,including:o Organic milk o Organic cheese o Cheese substitutes

from soy, rice, oralmonds

o Organic yogurto Organic chicken or

Cornish hen o Organic turkey o Organic pork o Organic lamb o Organic beefo Wild game Fish (especially cold-water fish):o Cod o Flounder o Halibuto Herring o Mackerel o Pollock o Salmon—fresh

or smoked o Sardines o Smelto Snapper o Tuna o Trouto Shellfish

Oils o Almond oil o Avocado o Canola oil o Flaxseed oil o Hazelnut oil o Mayonnaise (canola

oil-based) o Olives—black or

green o Olive oil o Pumpkin seed oil o Safflower oil o Sesame oil o Sunflower oil o Walnut oil

Beverages o Mineral water o Filtered water o Seltzer—plain or

flavored o Herbal teas o Decaffeinated tea o Fruit juices,

unsweetened(diluted)

o Rice, oat, or othergrain milks

o Nut milks

Sweeteners o Brown rice syrupo Molasses o SteviaFruit sweeteners,including:o Apple and grape

juice concentrateso Other natural

mixed fruitsweeteners

Condimentsand Spices o Chicken and

vegetable broths(low-sodium)

o Anise o Bay leaf o Basil o Bonito flakes o Caraway o Cardamon o Celery seedo Chili powder o Chives o Cinnamon o Coriander (cilantro)o Cumin o Dill o Fennel seed o Garlic o Ginger o Horseradish o Kudzu (thickener) o Marjoram o Minto Mustard, dry or

preparedo Nutmeg o Oregano o Parsley o Rosemaryo Saffron o Sageo Tarragon o Thyme o Turmeric o Vinegar

Foods that are particularly recommendedare indicated in bold print.

Legumes o Dried beans and

peas, including:o Garbanzo o Pinto o Kidneyo Black o Lima o Cannellini o Navy o Mung o Split peas o Lentilso Refried beans

(fat-free) o Sweet green peas o Sugar snap peas o Snow peas o Single-serving

bean soups Soy foods, including:

o Tofu o Tempeh o Miso o Soy beans—

green and black o Soy milk o Soy yogurto Texturized veg-

etable protein o Soy burgerso Soy nutso Tofu cream

cheese o Carob o Hummus

Vegetables o Artichokes o Arugula o Avocado o Asparagus o Bamboo shoots o Bell peppers—

red, green, orange,yellow

o Beets o Bok choy o Broccoli o Brussels sprouts o Burdock rooto Cabbage—red,

green, Chinese, Savoy o Carrots o Cauliflower o Celery

Vegetables o Celery root (celeriac) o Chives o Corn o Cucumber o Daikon radish o Eggplanto Fennelo Garlic o Green or yellow

snap beans o Greens, including:

o Beeto Chicoryo Collardo Dandeliono Endive o Escarole o Kaleo Lettuce—

romaine, red orgreen leaf

o Mustard o Radicchio o Spinach o Swiss chard o Turnipo Watercress

o Jalapeño peppers o Jicama o Juice—tomato,

carrot, or blendedvegetables

o Kohlrabio Leeks o Mushrooms, fresh

and dried o Okra o Onions o Parsnips o Plantains o Potatoes o Radishes o Rutabaga o Salsa (sugar-free) o Sea vegetables,

including:o Nori o Dulse o Hijiki o Kelp o Kombu o Wakame

o Shallots

Vegetables o Sprouts, including:

o Alfalfa o Clover

o Onion o Radish o Mung bean o Spaghetti squash o Summer squash —

yellow and green o Sweet potatoes o Taro rooto Turnips o Water chestnuts o Winter squash o Yams

Fruits o Appleso Applesauce o Apricots o Bananaso Blackberries o Blueberries o Cantaloupe o Cherries o Currants o Dates o Fresh and dried figs o Grapes o Grapefruito Honeydew melon o Juice, unsweetened

(diluted) o Kiwis o Lemons o Limeso Mangoes o Nectarines o Orangeso Papaya o Peaches o Pearso Pineapple o Plums o Prunes o Raisins o Raspberries o Strawberries o Tangerineso Watermelon

Shopping HealthyFoods that are particularly recommendedare indicated in bold print.

Researched, developed, and manufactured by Metagenics, Inc.

100 Avenida La Pata San Clemente, CA 92673, U.S.A.

www.metagenics.com

©2006 MetagenicsGESTM /MET1084 2/05 Rev 9/06

EstriumEstrium™

Medical Food